DR. CARROLL A CRADOCK


Address: 411 S Sangamon St, Suite 2a, Chicago, IL 60607-3547
Phone: 3122437441

DR. CARROLL A CRADOCK (NPI# 1316085954) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1316085954
Entity Type Individual
Full Name DR. CARROLL A CRADOCK
Credential PH.D.
Practice Address 411 S Sangamon St
Suite 2a
Chicago
IL 60607-3547
Practice Telephone 3122437441
Mailing Telephone 3122437441
Enumeration Date 2007-02-04
Last Update Date 2007-07-08
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
X 103TC2200X Psychologist
Specialization: Clinical Child & Adolescent
Behavioral Health & Social Service Providers
X 103TC0700X Psychologist
Specialization: Clinical
IL Behavioral Health & Social Service Providers

Office Location

Street Address 411 S SANGAMON ST
SUITE 2A
City CHICAGO
State IL
Zip Code 60607-3547

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1851883425 Alefiyah Zulfiqar Pishori Psychologist 1200 West Harrison St, Chicago, IL 60607 2018-05-30
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Taxonomy Information

Taxonomy Code 103TC2200X
Grouping Behavioral Health & Social Service Providers
Classification Psychologist
Specialization Clinical Child & Adolescent

Taxonomy Definition

Definition to come...
Notes: [1/1/2007: title modified]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1235647470 Laurie Gayes Thompson Psychologist 225 E Chicago Ave # 2, Chicago, IL 60611-2991 2018-01-22
1558874891 Claire Ashling Coyne Psychologist 225 E Chicago Ave # 10b, Chicago, IL 60611-2991 2017-11-08
1659721967 Micah Ioffe Psychologist 1300 W Belmont Ave Ste 501, Chicago, IL 60657 2016-06-16
1609243856 Humboldt Behavioral Health Group Psychologist 3317 W Le Moyne St, Chicago, IL 60651-2452 2015-08-24
1659610491 Alexandra M Psihogios Psychologist 1110 W Columbia Ave, Apt 1n, Chicago, IL 60626-4522 2013-02-13
1265781934 Anthony Thomas Vesco Psychologist 225 E Chicago Ave # 10a, Chicago, IL 60611-2991 2012-09-10
1689951519 Jesse Klein Psychologist 639 W Diversey Pkwy Ste 207, Chicago, IL 60614-1535 2011-11-06
1639357486 Victor J Bernstein Psychologist 2045 W Waveland Ave, Chicago, IL 60618-4949 2008-02-04
1114113487 Bradley C Stolbach Psychologist 6700 S. Promontory Drive, Chicago, IL 60649 2007-09-20
1023227469 Thomas F. Barrett Psychologist 1030 N. Clark St., Suite 303, Chicago, IL 60610 2007-05-22
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Competitor

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City CHICAGO
Zip Code 60607

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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